title: Measuring the quality of a childhood cancer care delivery system: quality indicator development.
abstract: OBJECTIVE
  A set of indicators to assess the quality of a childhood cancer system has not been identified in any jurisdiction internationally, despite the movement toward increased accountability and provision of high-quality care with limited health care resources. This study was conducted to develop a set of quality indicators (QIs) of a childhood cancer control and health care delivery system in Ontario, Canada.
  
  
  METHODS
  A systematic review and targeted gray literature search were conducted to identify potential childhood cancer QIs. A series of investigator focus group sessions followed to review all QIs identified in the literature, and to generate a provisional QI set for a childhood cancer system. QIs were evaluated by three content experts in a sequential selection process on the basis of a series of criteria to select a subset for presentation to stakeholders. Following an appraisal of the relevance of quality assessment frameworks, remaining QIs were mapped onto the Cancer System Quality Index framework.
  
  
  RESULTS
  The systematic review yielded few relevant childhood cancer system QIs. Overall, 120 provisional QIs were developed by the investigator group. Based on median QI rating scores, representation across the childhood cancer continuum, and feasibility of data collection, a subset of 33 QIs was selected for stakeholder consideration.
  
  
  CONCLUSIONS
  The subset of 33 QIs developed on the basis of a systematic literature review and consensus provides the basis for the selection of a set of QIs for ongoing, standardized monitoring of various dimensions of quality in a childhood cancer system.
authors.affiliation: Pediatric Oncology Group of Ontario (POGO), Toronto, ON, Canada.
authors.forename: Nicole M E
authors.initials: NM
authors.lastname: Bradley
authors.forename: Paula D
authors.initials: PD
authors.lastname: Robinson
authors.forename: Mark L
authors.initials: ML
authors.lastname: Greenberg
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Barr
authors.forename: Anne F
authors.initials: AF
authors.lastname: Klassen
authors.forename: Y Lilian
authors.initials: YL
authors.lastname: Chan
authors.forename: Corin M
authors.initials: CM
authors.lastname: Greenberg
mesh_terms: D002648:Child; D003625:Data Collection; D003695:Delivery of Health Care / Q000592:standards*; D005240:Feasibility Studies; D017144:Focus Groups; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D009864:Ontario; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care